Author Block M Matangi, U Jurt, P Dutchak, D Brouillard
BACKGROUND: In private practice the utilization of echocontrast in Ontario was poor because of a lack of reimbursement. That reimbursement is now available. Our facility has provided stress ECHO since 1995 and stress nuclear since 2002. The purpose of this analysis was to assess the effect of the availability of echocontrast on stress nuclear utilization.
METHODS: Our cardiology database was searched for all stress ECHO and stress nuclear studies for the months of January and February in the years 2011, 2012 and 2013. The use of contrast is documented in the database as are the rates of same day conversion to stress nuclear. It has been our practice to convert all patients with very poor ECHO images to stress nuclear and those with LBBB to Persantine nuclear. However, the largest group of patients are those referred back for stress nuclear based on the stress ECHO report.
RESULTS: See figure 1. There has been a dramatic increase in the use of contrast stress ECHO during the first 2 months of each year from 2 to 36 and now 59. This has been associated with an overall reduction in stress imaging from 541 to 497 to 490 during the same periods. Some of this is related to a small reduction in same day conversions. However the majority are due to a reduction in the need for further testing due to inadequate ECHO images. A recommendation for stress nuclear based on the stress ECHO being inadequate has dropped from 34 in 2011 to 16 in 2013, 53% reduction in the need for further testing.
CONCLUSION: The availability of contrast ECHO has had a significant impact on overall stress imaging utilization at our facility.
1. Overall stress imaging during the first 2 months of each year has dropped by 9.4%. For our facility this amounts to a reduction of 300 stress imaging studies annually. This is almost exclusively a reduction in stress nuclear.
2. Same day conversion to stress nuclear has dropped by 37%. Mostly related to patients with LBBB who are converted to Persantine MIBI.
3. Later conversion to stress nuclear has dropped by 53%. Many of these extra studies could be eliminated with an even wider use of echocontrast.
4. The overall savings to the healthcare system if translated to stress imaging in Ontario should be substantial.